(To be filled up by the BIR)

DLN:

Republika ng Pilipinas
Capital Gains BIR Form No.

1707
Kagawaran ng Pananalapi
Kawanihan ng Rentas Internas

BCS No./Item No.:

For Onerous Transfer of Shares of Stock Not Tax Return July, 1999 (ENCS)
Traded Through the Local Stock Exchage
Fill in all applicable spaces. Mark all appropriate boxes with an “X”.
1 Date of Transaction 2 Amended Return? 3 No. of Sheets Attached 4 ATC I I 030 Individual
(MM/DD/YYYY) 04/08/2017 Yes x No IC110 Corporation
Part I Background Information
5 TIN 6 RDO 7 TIN 8 RDO
Seller 114-071-975 Code 066 Buyer 454-112-001 Code 066
9 Seller's Name 10 Buyer's Name
MATILDA GONOWON JOSE RONALDO MARTINEZ SOHO
11 Registered Address 12 Registered Address
Larion Alto, Tuguegarao City Pallua Norte, Tuguegarao City
13 Zip Code 14 Zip Code

15 Are you availing of tax relief under an International Tax Treaty or Special Law?
Yes x No If yes, specify
16 Description of Tansaction
x Cash Sale Installment Sale Foreclosure Sale Others (specify)
17 Details of Installment Sale
364,000.00
17A Selling Price/Fair Market Value
200,000.00
17B Cost and Expenses
164,000.00
17C Mortgage Assumed

17D No. of Installments

17E Amount of Installment for this Payment Period

17F Date of Collection of Installment for this Payment Period (MM/DD/YYYY)

17G Total Collection (Downpayment and Installments) during the Year of Sale
Part II Computation of Tax
18 364,000.00
18 Taxable Base - For Cash Sale/ Foreclosure Sale (Schedule 1)
19 200,000.00
19 Less: Cost and Other Allowable Expenses (Schedule 2)
20 164,000.00
20 Net Capital Gain/ (Loss)
21 11,400.00
21 Tax Due on Entire Transaction (5% on the first 100,000 ; 10% over 100,000)(Cash Sale/Foreclosure Sale); or
22 Tax Due for this Payment Period 22 11,400.00
Computation of the Tax Due (If tax is payable under the installment method of computation)

23 -
23 Less: Tax Paid in Return Previously Filed, if this is an Amended Return
24 11,400.00
24 Tax Payable/(Overpayment)(Item 21 or 22 Less Item 23)
25 Add: Penalties
Surcharge Interest Compromise
25A - 25B - 25C - 25D -

26 Total Amount Payable/(Overpayment) (Sum of Items 24 & 25D) 26 11,400.00

Schedule 1 Description of Shares of Stock (attach additional sheets, if necessary)
Taxable Base
Name of Corporate Stock Stock Certificate No. No. of Shares Selling Price or FMV whichever is higher

Vestland Maritime Corporation VMC-CS-005 20000 364,000.00

0 0 0 -

0 0 0 -

27 Total (To Item 18) 364,000.00

I declare under the penalties of perjury, that this return has been made in good faith, verified by me, and to the best of my knowledge and belief,
is true and correct, pursuant to the provisions of the National Internal Revenue Code, as amended, and the regulations issued under authority thereof.

28 MATILDA GONOWON JOSE 29

Taxpayer/Authorized Agent Signature over Printed Name Title/Position of Signatory
Part III DetaIls of Payment Stamp of Receiving
Drawee Bank/ Date Office and Date of
Particulars Agency Number MM DD YYYY Amount Receipt
30 Cash/Bank 30
Debit Memo
31 Check 31A 31B 31C 31D

32 Tax Debit 32A 32B 32C

Memo
33 Others 33A 33B 33C 33D

Machine Validation/Revenue Official Recepts Details (If not filed with the bank)